Guidelines for the

administration of
medicines
One of the most important ways of serving the public interest is through providing advice and guidance to
registrants on professional issues. The purpose of these guidelines is to establish principles for safe
practice in the management and administration of medicines by registered nurses, midwives, specialist
nurses, and student nurses (under strict supervision and guidance).

This booklet is neither intended to be a rule book nor a manual. Nor is it intended to cover every single
situation that you may encounter during your career. Instead, it sets out a series of guidelines or principles
that we hope will enable you to think through the issues and to apply your professional expertise and
judgment in the best interest of your patients. It will also be necessary to develop and refer to additional
local policies or protocols to suit local needs. Within the document, the word patient is used for
convenience to refer to a person receiving medication, irrespective of the environment in which they are
residing.

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Protecting the public through professional standards
Principles in relation to the prescription

As a registered nurse, midwife, or specialist nurse, you are accountable for your actions and omissions. In
administering any medication, or assisting or overseeing any self-administration of medication, you must
exercise your professional judgment and apply your knowledge and skill in the given situation. When
administering medication against a prescription written manually or electronically by a registered medical
practitioner or another authorized prescriber, the prescription should:

• Be based, whenever possible, on the patient’s informed consent and awareness of the purpose
of treatment.
• Be clearly written, typed or computer-generated and be indelible.
• Clearly identify the patient for whom the medication is intended.
• Record the weight of the patient on the prescription sheet where the dosage of medication is
related to weight.
• Clearly specify the substance to be administered, using its generic or brand name where
appropriate and its stated form, together with the strength, dosage, timing, frequency of
administration, start and finish dates, and route of administration.
• Be signed and dated by the authorized prescriber.
• Not be for a substance to which the patient is known to be allergic or otherwise unable to
tolerate.
• In the case of controlled drugs, specify the dosage and the number of dosage units or total
course; if in an out-patient or community setting, the prescription should be in the prescriber’s
own handwriting; some prescribers are subject to handwriting exemption but the prescription
must still be signed and dated by the prescriber.

Instruction by telephone to a practitioner to administer a previously unprescribed substance is

not acceptable. In exceptional circumstances, where the medication has been previously
prescribed and the prescriber is unable to issue a new prescription, but where changes to the
dose are considered necessary, the use of information technology (such as fax or eMail) is the
preferred method. This should be followed up by a new prescription confirming the changes
within a given time period. The CSPC CHS suggests a maximum of 24 hours. In any event, the
changes must have been authorized before the new dosage is administered.

Prescribing by nurses, midwives, and specialist nurses

Note: Nurses, midwives, and specialist nurses must comply with the current legislation in the
Republic of the Philippines and be accountable for their practice.

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Dispensing

If, under exceptional circumstances, you are required to dispense, there is no legal barrier to this
practice. However, this must be in the course of the business of a hospital and in accordance with
the doctor’s written instructions.

In a dispensing doctor’s practice, nurses may supply to patients under a particular doctor’s care,
when acting under the directions of a doctor from that practice.

Dispensing includes such activities as checking the validity of the prescription, the appropriateness
of the medicine for an individual patient, assembly of the product, labelling in accordance with
legal requirements and providing information leaflets for the patient.

If you, as a registered nurse, midwife, specialist nurse, are engaged in dispensing, this represents
an extension to your professional practice. The patient has the legal right to expect that the
dispensing will be carried out with the same reasonable skill and care that would be expected
from a pharmacist.

Principles for the administration of medicines

In exercising your professional accountability in the best interests of your patients, you must:

Know the therapeutic uses of the medicine to be administered, its normal dosage, side
effects, precautions, and contraindications.
Be certain of the identity of the patient to whom the medicine is to be administered.
Be aware of the patient’s care plan.
Check that the prescription, or the label on medicine dispensed by a pharmacist, is
clearly written and unambiguous.
Have considered the dosage, method of administration, route, and timing of the
administration in the context of the condition of the patient and co-existing therapies.
Check the expiry date of the medicine to be administered.
Check that the patient is not allergic to the medicine before administering it.
Contact the prescriber or another authorized prescriber without delay where
contraindications to the prescribed medicine are discovered, where the patient develops
a reaction to the medicine, or where assessment of the patient indicates that the
medicine is no longer suitable.
Make a clear, accurate, and immediate record of all medicine administered, intentionally
withheld, or refused by the patient, ensuring that any written entries, and the signature
are clear and legible; it is also your responsibility to ensure that a record is made when
delegating the task of administering medicine.
Where supervising a student in the administration of medicines, clearly counter sign
the signature of the patient.

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Some drug administrations can require complex calculations to ensure that the correct volume or quantity
of medications is administered. In these situations, it may be necessary for a second practitioner to check
the calculation in order to minimize the risk of error. The use of calculators to determine the volume or
quantity of medication should not act as a substitute for arithmetical knowledge and skill.

It is unacceptable to prepare substances for injection in advance of their immediate use or to administer
medication drawn into a syringe or container by another practitioner when not in their presence. An
exemption to this is an already established infusion which has been instigated by another practitioner
following the principles set out above, or medication prepared under the direction of a pharmacist from a
central intravenous additive service and clearly labelled for that patient.

In an emergency, where you may be required to prepare substances for injection by a doctor, you should
ensure that the person administering the drug has undertaken the appropriate checks as indicated above.

Aids to support compliance

Self-administration from dispensed containers may not always be possible for some patients. If an aid to
compliance is considered necessary, careful attention should be given to the assessment of the patient’s
suitability and understanding of how to use an appropriate aid safely. However, all patients will need to be
regularly assessed for the continued appropriateness of the aid. Ideally, any compliance aid, such as a
monitored dose container or a daily/ weekly dosing aid, should be dispensed, labelled, and sealed by a
pharmacist.

Where it is not possible to get a compliance aid filled by a pharmacist, you should ensure that you are able
to account for its use. The patient has right to expect that the same standard of skill and care will be
applied by you in dispensing into a compliance aid as would be applied if the patient were receiving the
medication from a pharmacist. This includes the same standard of labelling and record keeping.
Compliance aids, which can be purchased by patients for their own use, are aids that filled from containers
of dispensed medicines. If you choose to repackage dispensed medicines into compliance aids, you should
be aware that their use carries risk of error.

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Self-administration of medicines

The CSPC CHS welcomes and supports the self-administration of medicines and the administration of
medication by carers wherever it is appropriate. However, the essential safety, security and storage
arrangements must be available and where necessary, agreed procedures, must be in place.

For the hospital patient approaching discharge, but who will continue on a prescribed medicines regime
on the return home, there are obvious benefits in adjusting to the responsibility of self-administration
while still having access to professional support. It is essential, however, that where self-administration is
introduced, arrangements are in place for the safe and secure storage of the medication, access to which
is limited to the specific patient.

Where self-administration of medicines is taking place, you should ensure that the records are maintained
appropriate to the environment in which the patient is being cared for.

It is also important that if you are delegating this responsibility, you ensure, that the patient or carer/ care
assistant is competent to carry out the task. This will require education, training, and assessment of the
patient or carer/ care assistant, and further support if necessary. The competence of the person to whom
the task has been delegated should be reviewed periodically.

Complementary and alternative therapies

Complementary and alternative therapies are increasingly used in the treatment of patients. Registered
nurses, midwives, specialist nurses who practice the use of such therapies must have successfully
undertaken training and be competent in this area (please refer to the CHS code of professional conduct:
standards for conduct, performance, and ethics). You must have considered the appropriateness of the
therapy to both the condition of the patient and any co-existing treatments. It is essential that the patient
is aware of the therapy and gives informed consent.

Management of errors or incidents in the administration of medicines

It is important that an open culture exists in order to encourage the immediate reporting of errors or
incidents in the administration of medicines. If you make an error, you must report it immediately to your
line manager or employer.
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Registered nurses, midwives, specialist nurses, who made an error, and who have been honest and open
about it to their senior staff, appear sometimes to have been made the subject of local disciplinary action
in a way that might discourage the reporting of incidents and, therefore, be potentially detrimental to
patients and the maintenance of standards.

The CSPC CHS believes that all errors and incidents require a thorough and careful investigation at a local
level, taking full account of the context and circumstances and position of the practitioner involved. Such
incidents require sensitive management and a comprehensive assessment of all the circumstances before
a professional and managerial decision is reached on the appropriate way to proceed. If practicing midwife
makes or identifies a drug error or incident, she should also inform her supervisor of midwives as soon as
possible after the event.

The CSPC CHS supports the use of local multi-disciplinary critical incident panels, where improvements to
local practice in the administration of medicines can be discussed, identified, and disseminated.

When considering allegations of misconduct arising from errors in the administration of medicines, the
CSPC CHS takes a great care to distinguish between those cases where the error was the result of reckless
or incompetent practice or was concealed, and those that resulted from other causes, such as serious
pressure of work, and where there was immediate, honest disclosure in the patient’s interest. The CSPC
CHS recognizes the prerogative of managers to take local disciplinary action where is considered to be
necessary but urges that they also consider each incident in its particular context and similarly discriminate
between the two categories described above.

Legislation

There are a number of pieces of legislation that relate to the prescribing, supply, storage, and
administration of medicines in the Philippines. It is essential that you comply with them.

• R.A. 9173
• R.A. 7392
• R.A. 9165

Queries are often raised in relation to prescriptions for controlled drugs. The prescription should:

• Be in ink or such as to be indelible, and be signed and dated by the prescriber, issuing it in their
usual handwriting with signature, and S2
• Specify the dose to be taken, and in the case of a prescription containing a controlled drug which
is a preparation, the form, and where appropriate, the strength of the preparation, and either the
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total quantity (in both words and figures) of dosage units, as appropriate, to be supplied; in any
other case, the total quantity (in both words and figures) of the controlled drug to be supplied. If
you have any queries in relation to the misuse of drugs, or if you are aware of illicit substances
being in the possession of a patient, you must refer to and act on local policy and/ or appropriate
government health department guidance.

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